Caucuses, Coffee Shop Focus Groups, and Cholesterol

I'd like to explore the connection between the current presidential campaign--including its caucuses and coffee shop interviews--with the direct-to-consumer (DTC) marketing of drugs like cholesterol. An Avodart print ad found in the February 11, 2008 issue of Forbes brought this connection to mind, although Avodart treats enlarged prostate and not high cholesterol:

Click on image to enlarge! and read why this is an optical illusion.

Obviously, this ad is politically incorrect, since for the first time in US history, a woman may be the Democratic candidate for president and women--even Hillary--do not have prostate glands. I guess the Avodart ad people we thinking of McCain, who probably does have a prostate issue; after all, one in three men will have such issues according to an ad for a different product I have seen on TV.

According to the Avodart Web site, "Nearly half of all men over the age of 50 have an enlarging prostate." Great! Along with the 40% of men over 50 who have erectile dysfunction, I have a lot to worry about! I am doomed!

You Call This Educational?
I love the little "educational" graphic down on the bottom right of the ad (image on left, below).


Aside from insulting my intelligence, this image immediately reminded me of the famous two-circles optical illusion shown on the right.

I'm sure I'm not the only guy with shrinkage on his mind that has made the optical illusion, smoke and mirrors connection. Which leads me to ask, don't they test these ads in consumer focus groups?


Coffee Shop Focus Group Discussion of Cholesterol
Back to politics, where everything is tested in focus groups, even if just gabbing with a few people in a coffee shop.

Not only is politics the topic of discussion in coffee shops around America these days, but so is high cholesterol and drugs that treat it. If a cholesterol drug were running in the Rx drug primaries, it would be the Giuliani of candidates! Vytorin and Zetia have dropped out of the race (see "Vytorin and Zetia Are Dead in the Water") and Crestor has re-emerged, phoenix-like, as a contender (see "Crestor Print Ad Touts Plaque Buildup Advantage").

In this month's Pharma Marketing News, I published the following article by Jim Avery, professor of advertising at the University of Oklahoma. He recounts his conversation with college-educated friends at a local coffee shop on the subject of cholesterol.

At breakfast last week in one of my favorite coffee shops, I was talking with some friends who I knew had some health problems. I mentioned that there were a couple of recent articles in newspapers on cholesterol drugs and clinical trials. No one had seen or even heard of these articles and I was a bit taken aback that I was the only one who had seen what I judged to be fairly important information on healthcare.

Impromptu Focus Group
One thing led to another and pretty soon we were having an in-depth discussion about their high cholesterol, general healthcare, the FDA, and what they think when they read news stories or advertising that relates to their ailment. Obviously, being a professor of advertising at the University of Oklahoma, I took the opportunity to turn our breakfast meeting into a little impromptu focus group.

All three of my friends--Jack, Rose, and Steve--are over the age of fifty, are college graduates, and two of the three have master's degrees.

Jack had a heart attack a few years ago. Prior to that time he did not go to a doctor on a regular basis. When he was in the hospital, he learned his triglycerides were too high and his doctor recommended that he start taking medication to bring them in line.

Rose found that her cholesterol level was high during a routine blood test. It appears to be a family heritage. At first, she tried to increase her exercise. She found it improved her test scores, but she was still just borderline. She decided to start taking the prescription recommended by her doctor in order to give her a margin of safety.

Steve has had several "episodes" with his heart, has been to several doctors in two different states, and has tried everything his doctors have recommended. Even with his diligence, he still did not have his high cholesterol under control. His wife found a program offered at a hospital that required total diet control, medication, and exercise. She said it is time for them to "take the offensive." He believes it saved his life. He recognizes that it is very stringent. No butter, no fat of any kind, can be included in his diet, ever.

Cholesterol Treatment in the News
I gave each of them copies of the articles on cholesterol, which I just happened to have with me. I had read these earlier in the week and gave my friends some time to read them while we enjoyed our coffee and doughnuts. One article was on new ways to treat cholesterol and the other revealed that a reduction in cholesterol does not necessarily lead to a reduction in heart disease.

In the first part of our discussion afterward, all three said was that their cholesterol medication is working for them. Rose and Steve commented on their latest blood work as evidence. Jack was certain that he was improving, too. When I challenged him on whether the medication is working or if he is just getting better on his own, Jack said there was no way for him to know, but he is confident that his improved health is directly related to the medicine.

All of them had done individual research on their ailment, diagnosis, and the treatment of medicines recommended by their doctors. After a short period of time, however, Rose and Jack soon left the details of their ailment and its treatment up to their doctors.

However, Steve, who is retired from both the Air Force and a management position, took more control of his heath. He monitors everything he eats—he didn’t have any doughnuts like the rest of us did that day—and he exercises regularly. He also sees his doctor regularly, and often takes articles from magazines or details from advertisements to show his doctor and asks for a recommendation.

I was surprised at how little Jack and Rose knew of their medical condition. Neither knew the difference between HDL and LDL. I suspect that they quit investigating when they felt confident that they were getting better physically and chose to therefore trust their doctors.

Surprising Lack of Trust
We are all aware that consumers do not trust big corporations, but I was surprised at how distrustful all three of these friends were of pharmaceutical companies. I never even brought up the subject of trust or reliability. Rose just commented that these companies are not trustworthy. I understood their distrust of advertising, but was surprised to find out that this distrust extended to the news media, doctors, and hospitals as well. Rose went so far to say that "drug companies lie to me" and both Jack and Steve agreed. They each had a comment to express their distrust, and each related a story about a doctor who gave bad advice. Steve said that it took him several years to correct a situation caused by a poor doctor.

On the positive side, they all had praise for their pharmacists. Rose and Steve both related personal experiences when their pharmacist had corrected a mistake their regular doctor had made. Both spoke of a prescription that might have caused harmful effects with another medication they were taking at the time. I shared my own story about being prescribed a penicillin based drug even though my chart noted my allergy. The pharmacist caught the error for me, also.

Surrogate Endpoints “Miss the Point”
One article I gave them referenced limited FDA requirements for drug testing, It flabbergasted all three of them. That the FDA does not require testing results to show a change in heart disease, but only requires that the research show that there is a reduction in cholesterol, seemed to miss the point to them. Steve noted that it is as if cholesterol has become the disease instead of the symptom.

FDA Not Doing Its Job?
They were all disappointed that the FDA permitted the sale of drugs that could have negative effects. Jack said that he had read that the FDA is a stickler for testing and that it often takes longer to get new drugs approved in our country than elsewhere in the world. He pointed out that this does not seem to be consistent with the current practice.

All three were disappointed with how long it takes to get a new drug to the market.
Jack brought up his distrust of insurance companies. Rose and Steve immediately agreed. Each related an experience when their HMO did not allow something they thought would have improved their health. Steve gets his prescriptions at the Air Force base. He has a list of what is available. His doctor told him that he could recommend a drug from the list, but it wouldn't help him. So now, Steve often pays for medication that is not covered under his plan.

Overall, I continue to be surprised at what little trust people have for anything that has to do with the healthcare industry. I knew, as I am sure you do, that consumers do not trust the pharmaceutical companies. My surprise is in two areas. First, the intensity of that distrust, and second, that this negative halo extends to the FDA and to virtually any news associated with these companies or with the government agencies responsible.

We Haven’t Reached Bottom Yet
It is likely that the distrust started with insurance companies and HMOs, but every time the news media report that a drug doesn't do what it was intended to do, or that people who took what had been tested to be a perfectly safe drug may have a serious side effect, the "bad will" meter goes up. This "bad will" is rubbing off on medical practitioners, marketers of pharmaceuticals and medical devises, and the FDA more all the time.

My small group discussion indicates to me that the situation is getting worse and that we probably have not yet hit bottom.

Note: The two articles referenced here were:
1. New Questions on Treating Cholesterol, New York Times, January 17, 2008
2. Study Reveals Doubt on Drug for Cholesterol, New York Times, January 15, 2008

Jim Avery is Professor of Advertising, and holds the Gaylord Endowed Professorship, at the University of Oklahoma. The meeting of “friends” in a coffee shop was a fictional embellishment of an actual focus group Avery recently held. Except for that and the names of the participants, everything else reported here is an accurate summary of the results of the focus group discussion.

You can learn more about professor Avery and his teaching techniques by listening to this Pharma Marketing Talk podcast: “Teaching New Dogs Old Tricks.”